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Home My WebLink About05-30-08 INRE: GUARDIANSHIP FOR THE MINOR CHILD JASON RYAN MILLER : IN THE COURT OF COMMON PLEAS .~, : OF CUMBERLAND COUNTY, P~YL V ~IA : ORPHANS' COURT DIVISION ~;;:g ~:,: j: --r- ...,.< ~ ~l.) C) On the Petition of Carol Graham : NO. _,:~:; ';:;2, ;: ") ':-- .. :JJ c.) PETITION FOR CITATION / RULE TO SHOW CAUSE ALAN GRAHA~-SHOU~ NOT BE APPOINTED GUARDIAN FOR THE MINOR CHILD JASON R AN MIL~R TO THE HONORABLE JUDGES OF THE CUMBERLAND COUNTY ORPHANS' COURT: 1. The Petitioner is Carol Graham, an adult individual, born December 27, 1972, who currently resides at 406 Cumberland Road, Lemoyne, Cumberland County, Pennsylvania 17043. 2. Respondent is Alan Graham, an adult individual, born July 21, 1970, who currently resides at 102 W. Vine Street, Shiremanstown, Cumberland County, Pennsylvania 17011. 3. Petitioner and Respondent were divorced from the bonds of matrimony on April 1, 2008. 4. Petitioner is the biological Mother of the subject minor child Jason Ryan Miller, born February 8, 1991. 5. Respondent has stood in loco parentis to the subject child since the child's birth. 6. Respondent is the legal and physical guardian for the minor child, under a Guardianship Agreement for the Minor Child Jason Ryan Miller dated May 22, 2008 (hereinafter "Guardianship Agreement"), a copy of which is attached hereto as "Exhibit "A". 7. The Petitioner and Respondent have consented to this Honorable Court entering a Decree appointing Alan Graham as the physical and legal guardian of the minor child Jason Ryan Miller, consistent with the terms and conditions of the attached Guardianship Agreement. WHEREFORE, Petitioner respectfully requests that this Honorable Court issue a Decree appointing Alan Graham as the legal and physical Guardian of the minor child Jason Ryan Miller, consistent with all the terms and conditions of the Guardianship Agreement dated May 22,2008. Date:' . Me affie, Esquire Scaringi & Scaringi, P.C. I.D. No. 90951 2000 Linglestown Road, Suite 106 Harrisburg, P A 17110 Telephone: (717) 657-7770 Fax: (717) 657- 7797 ~ caringi 1-= &6 ~ caringi Attorney. and CountI:elors at Law A ProEe..ional Corporation 2000 Linglesrown Road Suire 106 Harrisburg, P A 17110 Phone (717) 657-7770 Fax (717) 657-7797 www.scaringiIaw.com ejru.:A'RVI.7t:NS:J{IP :Aej'R'E'E:M'EN'I' :JO'R T':J{'E :MINO'R C3fILV J:ASON'RY.7t:N :MILL'E'R .rJ THIS AGREEMENT, made this U day of f\,.t~ ' 200E> , between CAROL GRAHAM and ALAN GRAHAM contains the terms of the guardianship of the minor child, JASON RYAN MILLER. The parties set forth and agree as follows: 1. CAROL GRAHAM, born December 27, 1972, is an adult individual who is the Mother of the subject minor child, JASON RYAN MILLER. 2. ALAN GRAHAM, born July 21, 1970, is an adult individual who has stood in loco parentis to the subject minor child, JASON RYAN MILLER since birth. 3. The biological father of the subject minor child is unknown and does not appear on the minor child's birth certificate. 4. JASON RYAN MILLER, age seventeen years, born February 8, 1991, a male child, is the minor child who is the subject of this Agreement. 5. The subject minor child, JASON RYAN MILLER resides with and is supported by ALAN GRAHAM. 6. As the biological mother of JASON RYAN MILLER, CAROL GRAHAM hereby designates and appoints ALAN GRAHAM as Legal and Physical Guardian for JASON RYAN MILLER. 7. JASON RYAN MILLER consents to the within designation of ALAN GRAHAM as his legal and physical guardian. 1 ~.caringi 1-:;;; &6 f:?, caringi Attorney. and Counselor. at Law A Profe.sional Corporation 2000 Lingleswwn Road Suite 106 Harrisburg, PA 17110 Phone (717) 657-7770 Fax (717) 657-7797 www.scaringilaw.com 8. The purpose of this Guardianship Agreement is to give legal authority to ALAN GRAHAM to allow the subject minor child to live in his home with him, and to be able to make medical and non-medical decisions regarding the care ofthe child, to be in full control.of the child, and to have full discretion and judgment regarding all matters involving the minor child. 9. CAROL GRAHAM hereby specifically authorizes ALAN GRAHAM to review the medical records for and make medical decisions regarding JASON RYAN MILLER, and to give permission to doctors, nurses, hospitals, and the like in order to perform necessary medical treatment upon JASON RYAN MILLER. In all respects, this provision is intended to provide ALAN GRAHAM with the same authority that CAROL GRAHAM would have with respect to the uses and disclosures ofthe protected health information of JASON RYAN MILLER under the Health Insurance Portability and Accountability Act of 1996, as amended (otherwise known by the acronym "HIP AA"). 10. In the event of CAROL GRAHAM's incapacity, debilitation, or death, the terms of this Guardianship Agreement shall remain in full force and effect unless this Agreement as removed by CAROL GRAHAM prior to such occurrence. 11. This Guardianship Agreement shall be effective immediately upon the signing of he parties and shall be entered as an Order of Court. 12. This Guardianship Agreement shall continue in full force and effect until such time at CAROL GRAHAM feels that such an Agreement is unnecessary or obsolete. Nothing in this Guardianship Agreement shall in any way diminish the rights of AROL GRAHAM with regard to the subject minor child. CAROL GRAHAM may, ithout consultation with ALAN GRAHAM, revoke this Guardianship Agreement at any ime by informing ALAN GRAHAM of said revocation. 4. This Agreement shall be construed pursuant to the laws of the Commonwealth of ennsylvania. 2 ~ caringi '~&6 ~ caringi Attonley. and Counselors at La.... A Profeu;,o1\al Corpor"tion 2000 Linglestown Road Suite 106 Harrisburg, P A 1711 0 Phone (717) 657-7770 Fax (717) 657-7797 www.scaringilaw.com IN WITNESS WHEREOF, the parties jointly and individually agree that each of the undersigned is legally bound hereby. eal1~ ;j ~,aJh1 CAROL GRAHAM, Mother Date: DS/d.?./Oq I I 4ft ALAN GRAHA , Guardian . ness - ignature) tJ3YR- t2.. ittli t\VL~ f./ ~ltW I i SL-~ttk-JJt91 P0. 1f;OD J,-U:;}~~W1AJ,,-f1f ~de fOUl ~VL S ~)1il~ ;4.. r'1 J { 0 ( Itness - Printe ame & Address) ~J^~d#- 7UL- .cWttness - Signature) Avv1Jl~'\lltL- fvvti VSo F1 ~ CO,YlvV;~ i. Sc-ttV4v~ lP ,C/ iOl{; 7-000 [)VtP)IeSn~AJ^ IZ-Al cwlk~ ~tlVVL4~l \-v) fA {111 D (Witness - Printed Name & Address) Date: 5" -22-08 COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF y!-'(U?H t N d On this, the ~ day of \,\^--ctV) , 200 ~ before me, a Notary Public, the undersigned officer, personally appeared CAROL GRAHAM, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, ~liFunlo set my hand and seal. , . .' Ilh.. . . . ..... 2---_ otaryp~ " ~ ., E . ~. LJ v mmlSSl0n xplres: NotARIAL SIAL tAIITHA L HORN NOtary PUbliC 1WP. DAUPHIN COUNty ~ ExPlr.. Oct 23. 2011 MY COft\n-...... 3 ~.caringi ,~&@ ~. caringi Attorney. and Coun.clon at Law A Profe..ional Corporation 2000 Linglestown Road Suite 106 Harrisburg, PA 17110 Phone (717) 657-7770 Fax (717) 657-7797 www.scaringilaw.com ACCEPTANCE OF NOMINATION AS GUARDIAN I, ALAN GRAHAM, hereby accept my nomination as Guardian of subject minor child, JASON RYAN MILLER. I understand that my nomination as Guardian permits me to act on behalf of the subject minor child. I understand that my rights and responsibilities toward JASON RYAN MILLER will become effective immediately upon the execution of the foregoing Agreement. I understand that I may only make decisions or take actions that are in the best interests of JASON RYAN MILLER. I understand that the foregoing Agreement does not in any way diminish the rights of CAROL GRAHAM regarding JASON RYAN MILLER. I understand that CAROL GRAHAM may revoke my designation as Guardian at any time, without consultation with me, by simply notifying me of the same. I will not present this Guardianship Agreement to anyone for any purpose if my authority under this document has been revoked by CAROL GRAHAM. I will not present this Guardianship Agreement in bad faith. I will only make decisions under the authority vested in me through this Guardianship Agreement which are in the best interests of JASON RYAN MILLER. Date: S -22 ~c:58'" ALAN GRAHAM COMMONWEALTH OF PENNSYLVANIA COUNTYOF\)A\Jft-hN : SS: On this, the cQf).. day of ~OA..{ , 200 f before me, a Notary Public, the dersigned officer, personally appearea ALAN GRAHAM, known to me (or satisfactorily raven) to be the person whose name is subscribed to the within instrument, and cknowledged that he executed the same for the purposes therein contained. WITNESS WHEREOF, I have hereunto set my hand and seal. I oz 'tz '00 ..'tdxl uotlltwwo:> no:> NIHlIIl1YQ lUAl WNNYHIIIeIM onQnlll ND'ON NIaH 1 VH!IM MS lVIl1VlON 4 ~.caringi ~&~ ~. caringi Attorney. and Coun.elor. at Law A Profe..ional Corporation 2000 Linglestown Road Suite 106 Harrisburg, PA 17110 Phone (717) 657-7770 Fax (717) 657-7797 www.scaringilaw.com CONSENT TO GUARDIANSHIP AGREEMENT I, JASON RYAN MILLER, age seventeen years, born February 8, 1991, hereby consent to the designation of ALAN GRAHAM as my legal and physical guardian as set forth in the foregoing Guardianship Agreement. I specifically consent to the disclosures of my protected health information under the Health Insurance Portability and Accountability Act of 1996, as amended (HIP AA) to ALAN GRAHAM. The rights and responsibilities of ALAN GRAHAM that arise under the Guardianship Agreement will become effective immediately upon the execution of the foregoing Agreement. Date: S /2 '"2 ICY) I I ~jv~/ JAsON RYAN MILLER --- COMMONWEALTH OF PENNSYLVANIA COUNTY OF -pA\} 'P\-t'l rJ On this, the rJ:;)., day of L(I;( CU-I , 200 f before me, a Notary Public, the undersigned officer, personally a~ed JASON RYAN MILLER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. : SS: INWl1NESSWHEREOF'~~ olary ublic ' My Commission Expires: NOTARIAL SEAL TAliTHA L HORN Notary Public SUSQUEHANNA TWP. DAUPHIN COUNtY My commllllon Expires Oct 23. 2011 5